Briefing Detail Page

Tackling Health Care Costs: Finding Common Ground

Despite slower health care spending growth over the last few years, long-term forecasts for overall health spending – and for public programs like Medicare – signal continuing concern.

The idea behind numerous recent proposals is to find lasting solutions, and some areas of consensus are beginning to emerge.

Many proposals recommend paying for value instead of volume through such delivery models as patient-centered medical homes and accountable care organizations. Some encourage improvements in market competition, by instituting competitive bidding and increasing the availability of information. There is also some agreement on establishing spending targets.

Which proposals can garner support from various policymakers and stakeholders? How much money would these proposals save and what would be their effect on quality of care? What would it take to get the ball rolling on consensus proposals, and what are the challenges to widespread adoption?

Len Nichols, director, Center for Health Policy Research and Ethics, George Mason University, assessed the cost-curbing potential of initiatives underway in both private and public sectors, including those in the Affordable Care Act.

Sheila Burke, adjunct lecturer in public policy, Harvard Kennedy School of Government, offered insights into the acceptability, across the political and stakeholder spectrum, of major components of various proposals.

Marilyn Serafini of the Alliance and Rachel Nuzum of Commonwealth co-moderated.

While proposals span different stakeholders and political ideologies, said Paul Ginsburg, they consistently called for the diminished role of fee-for-service models and the increased use of other payment approaches to promote coordination of care and improve patient outcomes.

The policy community should help providers already using alternative payment models and those trying or willing to make the transition, Len Nichols stated. He also noted that both government and private payers should give providers incentives to meet global targets.

Sheila Burke emphasized that in order to reform payment incentives and programs, proposals recommend linking payment to performance and focusing more on quality.

Giving greater authority to states to innovate will improve Medicaid, Ginsburg stated.

The SGR should not be fixed in isolation, but as part of a broad reform, Paul Ginsburg, president, Center for Studying Health System Change, stated at a December 13 Alliance briefing, Tackling Health Care Costs: Finding Common Ground.

Webcast: The Emerging Biosimilars Market

Open Enrollment Preview: Checking the Vitals of the Marketplaces

The Affordable Care Act's health insurance marketplaces rely on robust competition to control costs and to provide consumer choice. But the decisions of several large insurers to scale back their 2017 marketplace participation, and the failure of many health insurance co-ops will leave marketplace shoppers in many states with fewer choices than they had in 2016. Furthermore, those insurers remaining in the exchanges have often found their marketplace customers to be less healthy than they projected, and they are raising premiums in response. Our briefing focuses on these trends, what they mean for the long-term viability of the marketplaces, and what public policy steps can be taken to bring more healthy people into the risk pool and to encourage insurer participation in the individual market.